Blacks Research Articles

A NOVEL TIME USE APPROACH ON SUCCESSFUL AGING: RACIAL AND GENDER DISPARITIES IN DAILY PRODUCTIVE ENGAGEMENT

Abstract Background and Objectives Productive engagement (PE) represents a potential pathway toward successful aging (SA). Using time diary data, this study explored how U.S. older adults structure their daily lives in different productive roles, the impacts of these roles on one specific dimension of SA (self-rated health), and the extent to which these patterns differ by race and gender. Research Design and Methods We use data from the American Time Use Survey (n = 17,990) and sequence and cluster analyses to identify distinctive daily PE time-use patterns. Multivariable linear regression models were used to evaluate associations between these patterns and self-rated health, and the moderating roles of race and gender. Results Five PE clusters were identified: Low Degree of PE (29%), Moderate Unpaid Work & Light Social Participation (42%), Persistent Unpaid Work (12%), Persistent Paid Work (9%), and Persistent Social Participation (7%). White women were the most likely, while Black men were the least likely to have any PE. All PE clusters were positively associated with self-rated health, compared to “Low Degree of PE”. The strongest positive association was observed for “Persistent Paid Work,” especially for women. Racial differences were more prominent among women than men. The health benefits of PE were less pronounced among Black women than White women. Discussion and Implications The positive association between PE and self-rated health varies across race-gender groups. Future research should consider the persistent structural barriers that may prevent older adults with disadvantaged backgrounds, particularly Black women, from benefiting from PE and experiencing SA.

Changing the game but keeping to the rules

The vulnerabilities faced by social minorities in Brazil, such as women, Black people, and LGBTQ+ people, are also very prevalent in local gaming cultures. Because of this, members of these groups organize collectives through social media to debate strategies and to provide mutual support for their esports initiatives. In the last few years, many of these activist collectives were absorbed by formal esports organizations, with some of their members now leading equality and diversity initiatives for esports in Brazil. Nevertheless, the movement from grassroots activists to PR representatives has contradictions, especially considering how social media platforms mediate the transition between activism and cause marketing. This paper aims to highlight some of these ambivalences, and how they impact the most vulnerable esports workers in Brazil.

SOCIAL DETERMINANTS OF HEALTH AMONG CUSTODIAL GRANDMOTHERS: ADVANCING AN INTERSECTIONAL APPROACH

Abstract Racial disparities in custodial grandparenting, as well as disparities in the physical and mental health outcomes of custodial grandparents, are well-documented. As a result of long-standing socio-structural inequalities across the life course, custodial grandparents are disproportionately single, Black women with low socio-economic status. These categories of difference and the process of racialization contribute both to the need for grandparent caregiving in the Black community and the negative health consequences of caregiving for Black custodial grandmothers. Macro level structures and systems of oppression impact access to the social determinants of health shaping the life trajectories of racialized groups and contributing to unequal aging which suggests the importance of an intersectional lens when understanding the lived experiences of Black custodial grandmothers. A scoping review was conducted to determine the extent to which an intersectional framework is utilized in research examining the experiences of Black custodial grandmothers. A search of relevant databases (PsychINFO, SociINDEX, PubMed, and Web of Science) was performed using the following search terms and Boolean logic: (“grandparent” OR “grandmother” OR “grandfather” OR “custodial grandparent”) AND (“intersectionality”). Quantitative, qualitative, and mixed-methods peer-reviewed journal articles published in English through January 2024 were included. Findings suggest that research integrating intersectionality with large representative samples is limited. This presentation will propose a conceptual framework that integrates the social determinants of health with an intersectional life course perspective as proposed by Ferrer and colleagues (2017). Recommendations for future research using intersectional approaches will be offered.

RACE, NEIGHBORHOOD DYNAMICS, AND MORTALITY PATTERNS IN OLDER PUERTO RICANS

Abstract This study explores the relationships between race, neighborhoods, and mortality among older Puerto Ricans, drawing upon theoretical frameworks in sociology, gerontology, and public health. We combined data from the longitudinal Puerto Rican Elderly Health Conditions Project (PREHCO; 2002-2021) and the Puerto Rico Contextual Data Resource (PR-CDR) to examine how the relationships between racial identity, neighborhood-level racial density, and neighborhood-level socioeconomic status are related to the probability of experiencing all-cause mortality among island-dwelling Puerto Ricans aged 60 and older (n=4,243). Findings show that young-old Black Puerto Ricans residing in high socioeconomic neighborhoods have a lower risk of mortality relative to their same aged Black counterparts residing in low socioeconomic neighborhoods, and White Puerto Ricans who reside in either high or low socioeconomic neighborhoods. However, this mortality advantage diminishes when they reach the age of 75 years and over. We hypothesize that in Puerto Rico, Black communities with access to economic capital are especially beneficial for its residents as they are in spaces where they feel welcomed and are surrounded by amenities that are essential for healthy aging or survival into old age. As Puerto Ricans in these communities age, this advantage may diminish, due to a ceiling effect, meaning that for older Puerto Ricans who survive to age 60 in these communities, there are fewer advantages to accumulate. Our research provides a foundation for informed policy decisions and targeted interventions to promote aging in place in Puerto Rico and offers a framework for understanding similar dynamics in diverse Latin American contexts.

THE MEN IN DEMENTIA CAREGIVING: UNDERSTANDING MEN’S EXPERIENCES

Abstract About 30% of caregivers for family members with dementia are men, and their numbers are rising with the increasing prevalence of dementia. However, there is limited information in the extant literature about the number of men providing care to family members with dementia, their experiences, and their engagement in caregiving research. What is known is concerning. Men, like women, experience burden in the caregiving role and are at higher risk for health problems than non-caregivers. In addition, men may experience role confusion and feel unprepared to assume the caregiving role. Finally, little is known about what motivates men to participate in dementia caregiving research. Here we describe men’s experiences from three groups: Black American men, men caring for family members with primary progressive aphasia, and men caring for family members with advanced dementia. Along with quantitative and qualitative data, we will present findings from focus groups which center on men’s motivations for joining research studies, perceived benefits of research participation, and men’s concerns about research, including biospecimen collection. Unique insights and needs from each group will be addressed, along with strategies to promote recruitment and retention of men in caregiving research.

Supporting BIPOC Males in STEM: Insights from a Case Study on Online Peer Mentoring

The current study explores the implementation and impact of online peer mentee training, part of a larger online peer mentoring program, on the science, technology, engineering, and mathematics (STEM) self-efficacy, sense of belonging, and STEM identity of Black, Indigenous, and Other People of Color (BIPOC) males enrolled in STEM degree programs at a historically Black institution. Framed by Bandura’s Self-Efficacy Theory, Tinto’s Institutional department Model, and Social Cognitive Career Theory, it examines participants’ intent to persist in their STEM degree programs and subsequent STEM careers. Using a case study design, interviews and focus groups were analyzed. Five themes were identified: Development and Solidification of Identity, Increase in Confidence, Motivation to Make an Impact, Belonging, and Persistence and Retention through Developing Skills. The study is significant as it attends to the dearth in research that examines BIPOC males’ experiences in an online peer mentoring program while enrolled in STEM degree programs at historically Black colleges and universities (HBCUs). The findings provide insight on one method for supporting the participation of BIPOC males in STEM—an historically underrepresented population within STEM degree programs and fields. The findings inform institutions seeking to broaden participation within STEM fields while simultaneously supporting the retention of underrepresented populations in STEM degree programs. The findings also inform future implementations of online peer mentoring programs within HBCUs.

Associations of Traumatic Brain Injury and Hearing: Results From the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).

To examine associations of traumatic brain injury (TBI) with self-reported and clinical measures of hearing function. Four US communities. A total of 3176 Atherosclerosis Risk in Communities Study participants who attended the sixth study visit in 2016-2017, when hearing was assessed. Prospective cohort study. TBI occurring prior to the hearing assessment was defined using self-reported questions and "International Classification of Diseases-9th/10th Edition" (ICD-9/10) codes. Hearing function was assessed by self-reported questionnaires and clinically measured indices (audiometry [4-frequency pure tone average for each ear] and speech-in-noise testing). Linear, logistic, and multinomial logistic models adjusted for sociodemographics, vascular risk factors, and occupational noise exposure were used to examine associations. Participants were a mean age of 79years, 59% were female, 21% were of self-reported Black race, and 33% had a history of TBI (median time from first TBI to hearing assessment: 39years (25th-75th percentile=19-63years). Compared to participants without TBI, participants with prior TBI had higher age-adjusted prevalence of self-reported hearing loss (42.3% vs 35.3%), tinnitus (28.0% vs 23.8%), hearing aid use (23.4% vs 17.8%), pure tone average>40dB (30.6% vs 24.8%), and presence in the lowest quartile of speech-in-noise performance (27.6% vs 22.8%). With further adjustment, and particularly with adjustment for occupational noise exposure, associations with hearing measures were largely no longer statistically significant. In secondary analyses of associations of TBI frequency and severity with hearing function, results were similar to our main analyses, without evidence of dose-dependent associations. In this community-based cohort, prior TBI was associated with impaired hearing on both self-reported and clinically measured assessments, but these associations were attenuated after adjustment for occupational noise exposure. These results underscore the importance of the consideration of loud noise exposures, which may confound associations of TBI with hearing, in future studies.

"Our Golden Girl": Race, Politics, and Sport in the Creation of Identity in Post-colonial Zimbabwe

This paper offers a nuanced analysis of how sport intersects with race and gender in creating identities in post-colonial Zimbabwe. It traces the biography of Zimbabwe’s most successful Olympian swimmer, Kirsty Coventry, from her success at the 2004 Olympics in Athens to her appointment as the Minister of Sport in 2018. The selective acceptance of Coventry’s whiteness against the backdrop of a general rejection of white identity in Zimbabwe points to a nuanced understanding of race. It suggests that whiteness in Zimbabwe is not inherently incompatible with national identity but is often constructed as such for political expediency. Coventry’s case reveals that the state can redefine who is considered a legitimate Zimbabwean based on contributions to national pride and the political context. This flexibility in racial identity construction highlights the dynamic nature of postcolonial identity politics in Zimbabwe. Her victories came when Zimbabwe descended into a socio-economic and political crisis after the ruling ZANU PF regime took over white-owned farmers in a move meant to redress colonial land disposition. FormerPresident Robert Mugabe’s party created a narrative of white farmers as foreigners who did not belong and whose forefathers stole land from black Africans. As a white woman, she was part of these foreigners, yet the former president called her “golden girl” and awarded her US$100,000 in cash for her performance. Through content analysis of media coverage of her success and homecoming, we highlight how success in sport separated Coventry from colonial masters portrayed in the narrative ZANU PF has created around white people. Success in sport created an identity around Coventry, which had nothing to do with her race; she became a Zimbabwean, our golden girl.

Assessing Health Technology Literacy and Attitudes of Patients in an Urban Outpatient Psychiatry Clinic: Cross-Sectional Survey Study.

Digital health technologies are increasingly being integrated into mental health care. However, the adoption of these technologies can be influenced by patients' digital literacy and attitudes, which may vary based on sociodemographic factors. This variability necessitates a better understanding of patient digital literacy and attitudes to prevent a digital divide, which can worsen existing health care disparities. This study aimed to assess digital literacy and attitudes toward digital health technologies among a diverse psychiatric outpatient population. In addition, the study sought to identify clusters of patients based on their digital literacy and attitudes, and to compare sociodemographic characteristics among these clusters. A survey was distributed to adult psychiatric patients with various diagnoses in an urban outpatient psychiatry program. The survey included a demographic questionnaire, a digital literacy questionnaire, and a digital health attitudes questionnaire. Multiple linear regression analyses were used to identify predictors of digital literacy and attitudes. Cluster analysis was performed to categorize patients based on their responses. Pairwise comparisons and one-way ANOVA were conducted to analyze differences between clusters. A total of 256 patients were included in the analysis. The mean age of participants was 32 (SD 12.6, range 16-70) years. The sample was racially and ethnically diverse: White (100/256, 38.9%), Black (39/256, 15.2%), Latinx (44/256, 17.2%), Asian (59/256, 23%), and other races and ethnicities (15/256, 5.7%). Digital literacy was high for technologies such as smartphones, videoconferencing, and social media (items with >75%, 193/256 of participants reporting at least some use) but lower for health apps, mental health apps, wearables, and virtual reality (items with <42%, 108/256 reporting at least some use). Attitudes toward using technology in clinical care were generally positive (9 out of 10 items received >75% positive score), particularly for communication with providers and health data sharing. Older age (P<.001) and lower educational attainment (P<.001) negatively predicted digital literacy scores, but no demographic variables predicted attitude scores. Cluster analysis identified 3 patient groups. Relative to the other clusters, cluster 1 (n=30) had lower digital literacy and intermediate acceptance of digital technology. Cluster 2 (n=50) had higher literacy and lower acceptance. Cluster 3 (n=176) displayed both higher literacy and acceptance. Significant between-cluster differences were observed in mean age and education level between clusters (P<.001), with cluster 1 participants being older and having lower levels of formal education. High digital literacy and acceptance of digital technologies were observed among our patients, indicating a generally positive outlook for digital health clinics. Our results also found that patients of older age and lower formal levels of educational attainment had lower digital literacy, highlighting the need for targeted interventions to support those who may struggle with adopting digital health tools.

A Single Institution Experience With Immediate Lymphatic Reconstruction: Impact of Insurance Coverage on Risk Reduction.

Immediate lymphatic reconstruction (ILR) performed to prevent breast cancer related lymphedema is not consistently covered by insurance payors in the United States. Retrospective review was performed on a prospective database of ILR candidates from 2018 to 2022. Candidates were identified as patients with clinical axillary lymph node involvement at the time of breast cancer diagnosis. Patient demographics, insurance type, and development of lymphedema were recorded. One hundred and eighty ILR candidates were identified, 50 of whom underwent ILR. Non-ILR patients were more likely to be of black race, have Medicaid health insurance, earn lower median household income, and have lower rates of out-of-pocket payment when not covered by insurance. In 40 cases where ILR was indicated but not performed, 55% were due to financial reasons. After a minimum of 1 year follow up, 14.6% (6/41) of patients who underwent ILR had lymphedema, compared with 12.5% (9/72) of patients who had no clinical indication for ILR and 40% (10/25) of patients who did not undergo ILR when clinically indicated (p = 0.012). Disparities in insurance coverage and financial resources may adversely impact access and outcomes in patients clinically indicated for ILR.

Suicide Deaths by Occupation Skill Level and Educational Attainment in the US.

Estimate the association between suicide deaths and both occupation skill level and educational attainment in the US. Suicide deaths, employment, education and demographic data from the 2021 National Center for Health Statistics Multiple Cause of Death Files, for ages 18-64 with a lifetime history of employment were combined with comparable participants from the 2020-2022 Current Population Survey. Outcomes of interest were associations between suicide death and occupational skill level, assessed as a five-level variable, and educational attainment. Logistic regression models were used to estimate these associations before and after adjusting for educational attainment, age and sex, in each racial/ethnic sub-population. We found a significant gradient in suicide death across occupation skill levels, with lower-skill occupations associated with higher suicide rates than higher-skill occupations. This gradient was more pronounced among non-Hispanic White (NHW) people and Non-Hispanic Black (NHB) people than Hispanic people. However, upon controlling for educational attainment, this association was attenuated, indicating that the initial link was likely confounded by education. The results suggest that educational attainment is a more robust predictor of suicide risk than occupation skill level. Targeted interventions addressing educational and ethnic disparities within higher-risk occupational groups can mitigate suicide risk.

Comparing the predictive validity of four MCI definitions for incident dementia in demographically diverse community-dwelling individuals: Results from the Einstein Aging Study (EAS).

Research examining (MCI) criteria in diverse and/or health-disparate populations is limited. There is a critical need to investigate the predictive validity for incident dementia of widely used MCI definitions in diverse populations. Eligible participants were non-Hispanic White or Black Bronx community residents, free of dementia at enrollment, with at least one annual follow-up visit after baseline. Participants completed annual neurological and neuropsychological evaluations to determine cognitive status. Dementia was defined based on DSM-IV criteria using case conferences. Cox proportional hazard models assessed predictive validity for incident dementia of four specific MCI definitions (Petersen, Jak/Bondi, number of impaired tests, Global Clinical Ratings) at baseline, controlling for age, sex, education, and race/ethnicity. Time-dependent sensitivity and specificity at 2-7 years for each definition, and Youden's index were calculated as accuracy measures. Participants (N = 1073) ranged in age from 70 to 100 (mean = 78.4 ± 5.3) years at baseline. The sample was 62.5% female, and educational achievement averaged 13.9 ± 3.5 years. Most participants identified as White (70.0%), though Black participants were well-represented (30.0%). In general, MCI definitions differed in sensitivity and specificity for incident dementia. However, there were no significant differences in Youden's index for any definition, across all years of follow-up. This work provides an important step toward improving the generalizability of the MCI diagnosis to underrepresented/health-disparate populations. While our findings suggest the studied MCI classifications are comparable, researchers and clinicians may choose to consider one method over another depending on the rationale for evaluation or question of interest.

Composing Ethical Communities of Antiracism in Tulsa’s Black Wall Street

After the poststructuralist turn, prominent rhetorical theorists (Davis; Gehrke; Vitanza) invoked Jean Luc Nancy’s philosophy to critique rhetorics of community as a problem of totalitarianism, or immanentism (the drive for oneness). Yet, the perpetual critique of community needs ethical supplementation when an actual, existing community needs to exclude for protection. This article considers how Ibram X. Kendi offers a normative basis through which Black antiracist communities must contextually exclude “nonracist” and racist values for protection and to enable flourishing—thus, putting into tension an influential poststructural theory of community with an actual historical community built on tacit antiracist principles. We compare and contrast Nancy and Kendi’s respective approaches to the challenges of the ethics of community through a discussion of the “Buy Black” economic protections of Tulsa’s Black Wall Street in the U.S. segregation era.

Maternal and Infant Health Outcomes in US-Born and Non–US-Born Black Pregnant People in the US

With disparate Black maternal health outcomes in the US and a steadily expanding non-US-born Black population, it is beneficial to investigate Black maternal health outcomes by country of origin. To compare the prevalence of maternal morbidity and infant birth outcomes between US-born and non-US-born Black populations in the US. This cross-sectional study included all registered hospital births in the US from the 2021 National Vital Statistics Systems (NVSS) Natality Data. Eligible patients identified as Black, excluding those who were younger than 15 years, gave birth to twins or multiple infants, gave birth outside of a hospital, or were missing data for maternal morbidity, nativity, or study covariates. Maternal birthplace, characterized as born within the US or born outside of the US. Five maternal morbidities (ie, maternal transfusion, perineal laceration, ruptured uterus, unplanned hysterectomy, admission to intensive care unit) and two birth outcomes (low birthweight, preterm birth). Logistic regression analyses were utilized to calculate the associations of maternal morbidity and adverse birth outcome with maternal birthplace. Of a total 3 669 928 registered births in the US in 2021, 499 409 births to mothers who identified as Black were included in analysis; the majority of individuals were aged 20 to 24 years (117 173 [23.5%]), 25 to 29 years (142 890 [28.6%]), or 30 to 34 years (123 485 [24.7%]). Maternal birthplace in the US was associated with a decreased odds of experiencing any maternal morbidity (4411 of 403 822 births [1.1%]) compared with Black people born outside of the US (1593 of 95 587 births [1.7%]) (aOR, 0.67; 95% CI, 0.62-0.71). US-born Black people were significantly less likely to experience 3 of 5 maternal morbidities compared with non-US-born Black people: maternal transfusion (aOR, 0.87; 95% CI, 0.78-0.97), perineal laceration (aOR, 0.43; 95% CI, 0.39-0.48), and ruptured uterus (aOR, 0.63; 95% CI, 0.45-0.89). US-born Black people also had a nonsignificant decrease in odds for unplanned hysterectomy (aOR, 0.77; 95% CI, 0.56-1.05) and admission to intensive care unit (aOR, 0.92; 95% CI, 0.79-1.07). However, they were at increased odds of experiencing key adverse infant health outcomes, including low birthweight (aOR, 1.62; 95% CI, 1.58-1.67) and preterm birth (aOR, 1.51; 95% CI, 1.47-1.55). In this cross-sectional study, significant differences were observed in odds of maternal morbidity and birth outcomes by maternal birthplace within the Black pregnant population in the US. This suggests the need for increased assessment of nativity in Black maternal health research and specific strategies to reduce morbidity for non-US-born populations.

Correlates of peoples’ fearfulness of, and inaccuracy about, police during the COVID-19 pandemic

PurposeThe George Floyd anti-police protests had substantial material and social impacts on police departments around the country in 2020, yet, little is known about the correlates of attitudes towards police during this period. Even less is known about what role key aspects of the COVID-19 pandemic context, in addition to misinformation about police, might have played.Design/methodology/approachI construct two regression models (one multinomial, one ordinary least squares) analyzing a sample of 1,401 adults in the United States, collected between September and October of 2020. I include key indicators of institutional trust (e.g. trust in news media and trust in medical authorities), of pandemic context (e.g. importance of mask wearing and of social distancing) and of misinformation about policing (e.g. accuracy in estimates about police killings).FindingsResults indicate that people reporting higher trust in news media were more fearful of police mistreatment and that those who were more objectively inaccurate about the number of unarmed Black men killed by police were also more fearful of police mistreatment. These effects were found net of demographic controls (i.e. race, age, sex, SES) and net of attitudes about the COVID-19 pandemic. Additionally, trust in news media was directly associated with objective statistical inaccuracy about the racial distribution of people killed by police.Originality/valueThis is the first study to show that, in 2020, both fear of police mistreatment and being misinformed about police behavior were connected and appear to have been exacerbated by peoples’ trust in news media. An implication of this is that exposure to misinformation in news media may have a direct effect on negative attitudes towards police which, in turn, may increase peoples’ fear of police mistreatment.

An Exploration of How Medication-Assisted Treatment Employees Respond to Stress in Justice Settings.

Individuals who work in medication-assisted treatment (MAT) programs that serve justice-involved populations face challenging conditions that can cause elevated levels of stress. Although some studies focus on stress faced by MAT professionals, few examine their coping mechanisms. This study applies the Mayo Clinic's "4A's" of stress management-accept, adapt, avoid, and alter-to better understand ways medical staff working in MAT programs manage stress. The research team used NVivo software to analyze original qualitative data from 83 MAT employees servicing justice-involved populations. The 4A's framework successfully applies to the MAT employee context. Specifically, respondents relied on the stress management techniques accept and adapt more often than avoid and alter. Descriptive demographic trends were found in the data, including Black females most often reporting they accept and adapt to stress at work. In contrast, White females chose acceptance over other management tactics, although they also reported avoidance more than other groups. MAT organizations should empower employees to amend stressors to improve personal and professional outcomes. Future studies should use qualitative and quantitative methods to examine stress in industries with compounding stressors, such as MAT professionals working in justice settings.

Racial disparities in gestational weight gain and adverse pregnancy outcomes among Black and White pregnant people with obesity.

This study of pregnant people with obesity examined two aims in testing the hypothesis that the COVID-19 pandemic widened racial disparity in maternal health in high-risk pregnancies; it compared by race both (1) gestational weight gain (GWG) patterns and (2) patterns of preexisting conditions and adverse pregnancy outcomes. This retrospective chart review included birth certificate and delivery records from a large women's specialty hospital in Louisiana between 2018 and 2022. Differences in preexisting conditions, GWG, and adverse pregnancy outcomes were explored across early-, peak-, and late-pandemic periods using log-linear regression and robust Poisson models. Among 7431 deliveries (54% Black), Black pregnant people had higher rates of preexisting type 2 diabetes and chronic hypertension but lower rates of gestational diabetes and preeclampsia compared to White pregnant people across all periods. Black individualshad higher prepregnancy weight and lower GWG compared to White individuals across all periods. GWG differences were not significant in peak- and late-pandemic periods. Black individualswith obesity started pregnancy with higher weight and more preexisting conditions but had lower GWG compared to White individuals. Exacerbated disparities in preexisting conditions demonstrate higher health risks for Black individuals during pregnancy.

An Intersectional Approach to Testing Explanations of the Black-White Mental Health Paradox

Researchers have sought to explain Black Americans’ lower rates of common mental illnesses than White Americans, despite greater stress exposure, yet few explanations of this paradox are supported empirically. We examined the extent to which the paradox is owing to: Black Americans’ racial identity and religiosity resources offsetting the ill-effects of stressors, limited empirical attention to externalizing mental health outcomes, and the homogenization of both racial groups by disregarding within-group gender differences. Data came from the 25,454 Black and White men and women of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions. We used structural equation modeling to test for indirect effects of race on mental health via stressors, racial identity, and religiosity, and tested multigroup models by gender. Results indicated that the paradox could reflect the failure to account for Black Americans’ increased risk of substance-use disorders and greater symptoms of poor mental health. Racial identity did not explain variations in mental disorder by race overall, but it protected against all mental disorders for Black women. Findings also indicated complex effects of Black Americans’ greater religiosity. Greater religious importance exacerbated some mental health problems, whereas religious service attendance had protective effects, especially among women. Future research on explanations of the paradox should continue to incorporate multiple mental health outcomes and investigate intersectional identities.

Racial and Ethnic Disparities in the Outcomes and Treatment of Patients Admitted with Heart Failure: A Nationwide Analysis

Background/Objectives: Heart failure is the leading cause of hospital admission and mortality. Racial disparities have been demonstrated in various cardiovascular disorders; however, the data for in-hospital outcomes, complications, and procedural rates are limited. Methods: Utilizing the National Inpatient Sample (NIS) database, this retrospective cohort study included adult patients admitted with a principal diagnosis of heart failure. Coding for race and ethnicity in the NIS combines self-reported race and ethnicity provided by the data source into 1 data element (“RACE”). We compared the outcomes between various racial groups, focusing on mortality, the length of stay (LOS), hospital charges, and complications. Differences in the utilization of advanced therapies, including implantable cardiac defibrillators, cardiac resynchronization therapy (CRT), ventricular assist devices (VADs), and heart transplant, were also analyzed. Results: Out of 1,107,860 patients hospitalized with heart failure, 715,345 (64.57%) patients were White, 244,394 (22.06%) patients were Black, and 97,063 (8.31%) patients were Hispanic. Compared to White people, the odds of in-hospital mortality were lower among Black (aOR 0.74; 95% CI 0.68–0.81; p &lt; 0.001) and Hispanic (aOR 0.78; 95% CI 0.69–0.88; p &lt; 0.001) people. Complication rates including cardiogenic shock were found to be significantly lower in Black people (aOR 0.86; 95% CI 0.77–0.96; p &lt; 0.001) and in Hispanic (aOR 0.72; 95% CI 0.63–0.81; p &lt; 0.001) people. The rates of acute respiratory failure were also lower in Black (aOR 0.72; 95% CI 0.69–0.74; p &lt; 0.001) and Hispanic (aOR 0.77; 95% CI 0.73–0.81; p &lt; 0.001) people as opposed to White people. However, Black people were found to have higher rates of acute kidney injury (aOR 1.11; 95% CI 1.07–1.14; p &lt; 0.001) and cardiac arrest (aOR 1.17; 95% CI 1.03–1.34; p = 0.02) compared to White people. Black people were less likely to receive advanced interventions, including cardiac resynchronization therapy (aOR 0.71; 95% CI 0.60–0.83; p &lt; 0001), a ventricular assist device (aOR 0.45; 95% CI 0.34–0.59; p &lt; 0.001), and heart transplants (aOR 0.57; 95% CI 0.42–0.77; p &lt; 0.001), than White people. Hispanic people were found to have lower rates of ventricular assist device (aOR 0.49; 95% CI 0.33–0.72; p &lt; 0.001) use than White people. Conclusions: These findings highlight significant racial disparities in mortality, secondary outcomes, and advanced therapy utilization in heart failure admissions. Further research is needed to identify the root factors for these disparities in order to guide targeted interventions to reduce this racial gap.

Association of Social Determinants of Health With Brain MRI Outcomes in Individuals With Pediatric Onset Multiple Sclerosis.

Accumulating evidence points to worse clinical outcomes among adults with multiple sclerosis (MS) belonging to minority or poverty-affected groups. By contrast, little is known about the outcomes of these populations with pediatric-onset MS (POMS). Individuals with POMS represent 5% of the MS population and are more racially diverse yet have been understudied regarding socioeconomic environment or characteristics. In this study, we investigated the association between childhood social determinants of health (SDOH) and brain MRI outcomes in patients with POMS. This is a retrospective single-site cohort study of patients with POMS with brain MRI quantitatively analyzed using icobrain software to yield total white matter lesion, black hole, whole brain, white matter, and gray matter volumes. All patients with POMS evaluated at New York University Langone MS Center and who underwent high-quality volumetric MRI scans were included in this study. SDOH indicators of race, ethnicity, health insurance type, parental education, and childhood neighborhood social vulnerability index (SVI) were examined for association with MRI outcomes using linear least absolute shrinkage selection operator penalized regression modeling. Disease-modifying therapy (DMT) timing and DMT efficacy were compared for each SDOH category. A total of 138 patients with POMS (70% female) were included with a mean age of 19.86 years and median disease duration of 4 years at time of scan. Public health insurance, Black race, Hispanic ethnicity, low parental education, and high SVI (greater neighborhood disadvantage) were each associated with white matter lesion and black hole volume. SVI was the strongest individual predictor of total white matter lesion (β = 4.63, p = 0.002) and black hole volume (β = 2.91, p = 0.003). In models incorporating all SDOH variables, public health insurance was the strongest predictor of total lesion (β = 2.48, p = 0.01) and black hole volume (β = 1.50, p = 0.02), attenuating the effect of SVI (β = 1.66, p = 0.33 and β = 1.00, p = 0.39). There were no differences in DMT timing or efficacy between categories of social disadvantage. Individual-level and neighborhood-level indicators of social disadvantage are associated with worse brain MRI outcomes in POMS. Further investigation of race, ethnicity, and childhood disadvantage as risk factors of MS susceptibility and severity is needed to reduce MS health disparities.